Use of Antipsychotics Doubles for Low-Income Kids

Tennessee study suggests treatment decisions are behind trend

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HealthDay Reporter

WEDNESDAY, Aug. 4, 2004 (HealthDayNews) -- The use of antipsychotic drugs among low-income children in Tennessee nearly doubled between 1996 and 2001, a new study finds.

The increase, seen largely among children diagnosed with attention-deficit/hyperactivity disorder (ADHD), conduct disorder and affective disorders such as depression, has experts worried that young people who are not psychotic are being prescribed antipsychotic drugs for which there is no data on safety or effectiveness.

"The medicine certainly has hardly been studied at all in kids," said Dr. William Cooper, an associate professor of pediatrics at Vanderbilt University in Nashville. His report appears in the Aug. 3 issue of the Archives of Pediatric Adolescent Medicine.

Newer antipsychotic medications are approved for use in children with illnesses such as psychosis or Tourette syndrome. Other than that, the effect of their use is largely an unknown, at least in this population, Cooper said.

Cooper started noticing an increase in the number of young patients he was seeing who were taking newer generation antipsychotics in the late 1990s.

This led him to conduct an analysis of children aged 2 through 18 who were enrolled in TennCare, Tennessee's program for Medicaid enrollees and uninsured individuals. Patient files included demographic information as well as prescription information. Files on about 300,000 children and adolescents were available for each year from 1996 to 2001.

The proportion of TennCare children who were started on antipsychotics nearly doubled in six years, from 23 per 10,000 children in 1996 to 45 per 10,000 children in 2001. The increases were most dramatic among those aged 6 to 12 (a 93 percent rise) and those aged 13 to 18 (a 116 percent increase). Use among preschool children increased 61 percent.

The use of the drugs for behavioral problems associated with ADHD and mood disorders more than doubled. Teens had a threefold increase in the use of these drugs for ADHD and conduct disorder, meaning that nearly one in every 100 adolescents covered under the program was taking antipsychotics for these reasons, the study found.

Part of the explanation for the increase may have been the introduction, in the 1990s, of a new generation of antipsychotics that included clozapine, risperidone, olanzapine, quetiapine fumarate and ziprasidone hydrochloride, which may be perceived as safer by some physicians. Older antipsychotics such as Haldol had severe neurological side effects and were reserved for those who absolutely had to have them.

"In the mid-1990s there were some newer antipsychotics which were as powerful but didn't have the side effects, so people began to think maybe these are safe," Cooper said. "It turns out you really are trading neurologic side effects for other side effects, including obesity, type 2 diabetes and, rarely, heart arrhythmia. From preliminary studies, it looks as if those problems [side effects] are more pronounced in kids."

Another concern, according to Cooper, is that the newer drugs weren't designed for treating problems such as ADHD, although there is some evidence they may help with severe disruptive behavior, he added.

Dr. Melvin Oatis, an assistant professor of clinical psychiatry at New York University Child Study Center in New York City, said he has also noticed an increase in the use of these drugs for children and teens who aren't psychotic.

When they are prescribed to a non-psychotic child, "it's because of a severe conduct disorder, a child who sets fires, is cruel to cats, skips school, someone who is headed towards trouble," he said. "Those are the kids that we would give antipsychotic medication to sooner in the hopes that it is going to thwart some of their misbehaviors."

Antipsychotic drugs may also be given to children who are autistic and in danger of harming themselves or their caregivers, Oatis said. "Giving them antipsychotics has been very beneficial in terms of controlling behavior," he said.

But, he added, he could not say if the increase he is seeing among his patients in New York City is similar in any way to the one Cooper noticed among his Tennessee population.

Whether the drugs are beneficial or not, to Cooper the point is still clear. "We need to study these medications," he said.

In the meantime, he is starting research to see if the same drug-prescription patterns can be observed nationally among insured children.

More information

Visit the American Academy of Child & Adolescent Psychiatry for more on psychiatric medication for children.

SOURCES: William O. Cooper, M.D., associate professor, pediatrics, Vanderbilt University Medical Center, Nashville, Tenn.; Melvin Oatis, M.D., assistant professor, clinical psychiatry, New York University Child Study Center, New York City; Aug. 3, 2004, Archives of Pediatric Adolescent Medicine

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